Healthcare Provider Details

I. General information

NPI: 1073622189
Provider Name (Legal Business Name): CHRISTOPHER KENNY TEMPLETON IV D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 3RD ST STE A
EDMOND OK
73034-3822
US

IV. Provider business mailing address

125 E 3RD ST STE A
EDMOND OK
73034-3822
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-3735
  • Fax: 405-216-5363
Mailing address:
  • Phone: 405-216-3735
  • Fax: 405-216-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5087
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: